三角纤维软骨复合体（TFCC）外伤性损伤 - 采用高分辨率 3-T MRI 对 Palmer 分类法的细化。
Traumatic injury of the triangular fibrocartilage complex (TFCC)-a refinement to the Palmer classification by using high-resolution 3-T MRI.
机构信息
Department of Radiology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035, China.
Department of Hand Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035, China.
出版信息
Skeletal Radiol. 2020 Oct;49(10):1567-1579. doi: 10.1007/s00256-020-03438-4. Epub 2020 May 5.
OBJECTIVE
The aim of this study was to investigate the MR features of the traumatic injury of the triangular fibrocartilage complex (TFCC) by using high-resolution 3-T magnetic resonance imaging (MRI) and to refine the Palmer classification system.
MATERIALS AND METHODS
From November 2015 to May 2019, sixty-seven patients met the including and excluding criteria and were enrolled into this retrospective study. All subjects had high-resolution 3-T MRI scan of the wrist and eleven had indirect MR arthrography of the wrist. All the MRI were read by two experienced musculoskeletal radiologists. Diagnostic sensitivity, specificity, and accuracy of MRI were calculated by using the arthroscopy and surgery as the standard of reference. A P value less than 0.05 was considered statistically significant. The interobserver agreement was assessed by kappa analysis.
RESULTS
There were 49 cases of TFCC injuries proven by the arthroscopy or surgery. The TFCC injuries in the other 18 patients were proved by the combination of clinical follow-up examination and follow-up MRI. Among the arthroscopy- or surgery-confirmed cases, there were 32 patients with original Palmer injuries (IA = 10, IB = 19, ID = 3), 5 with capsular detachment, 4 with bucket-handle tear of the TFCC that have rarely been reported, and 8 with complex injuries that involved the listed classifications above. The sensitivities and specificities of MRI for diagnosing IA, IB, ID, complex injuries, and bucket-handle tear were 67-100% and 90-100%, and overall good to perfect interobserver agreements (kappa, 0.64-1.00). The diagnostic performance for the capsular detachment was lower (kappa, 0.38).
CONCLUSION
With high-resolution 3-T MRI, more detailed injury patterns were found including capsular injuries, the horizontal tear of the articular disk, and the bucket-handle tear. It is necessary to refine the classic Palmer classification of TFCC injuries.
目的
本研究旨在通过高分辨率 3T 磁共振成像（MRI）研究三角纤维软骨复合体（TFCC）外伤性损伤的 MRI 特征，并对 Palmer 分类系统进行细化。
材料与方法
2015 年 11 月至 2019 年 5 月，符合纳入和排除标准的 67 例患者被纳入本回顾性研究。所有患者均行高分辨率 3T 腕关节 MRI 扫描，11 例行腕关节间接 MRI 关节造影术。两位有经验的肌肉骨骼放射科医生对所有 MRI 进行阅读。以关节镜和手术为参考标准，计算 MRI 的诊断敏感度、特异度和准确率。P 值小于 0.05 被认为具有统计学意义。采用 Kappa 分析评估观察者间的一致性。
结果
49 例患者的 TFCC 损伤经关节镜或手术证实。其余 18 例患者的 TFCC 损伤通过临床随访检查和随访 MRI 证实。在关节镜或手术证实的病例中，有 32 例为原发性 Palmer 损伤（IA = 10，IB = 19，ID = 3），5 例为关节囊分离，4 例为 TFCC 桶柄撕裂，这是很少报道的，8 例为涉及上述分类的复杂损伤。MRI 诊断 IA、IB、ID、复杂损伤和桶柄撕裂的敏感度和特异度分别为 67-100%和 90-100%，观察者间具有良好到极好的一致性（kappa 值，0.64-1.00）。关节囊分离的诊断性能较低（kappa 值，0.38）。
结论
高分辨率 3T MRI 可发现更详细的损伤模式，包括关节囊损伤、关节盘水平撕裂和桶柄撕裂。有必要对 TFCC 损伤的经典 Palmer 分类进行细化。
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